Abnormal Labor

The affiliated hospital of Guizhou medical university

Abnormal labor
Definition: it is also called dystocia.
       Productivity, birth canal, fetus, mental
and psychological factors, Any one
exception or four factors can't
mutually Adapt to the person who is
obstructed by the birth process.
Abnormal uterine action
 force of labor

The main force of labor is uterine

contractility, which runs through the
whole labor process. Abnormal
uterine action mainly manifested as
abnormal uterine contractility.
abnormal uterine contractility
The characteristics of uterine contraction
(rhythm, symmetry, polarity) and the
intensity of uterine contraction change.
 Abnormal uterine contractility

uterine inertia

metrypercinesia
§1 uterine inertia
【 cause 】
1 、 cephalopelvic disproportion or abnormal
fetal position (secondary) :
● themain reason is that the fetus can not
close to the lower part of the uterus, can not
cause reflex uterine contraction, and cause
uterine contraction fatigue.
【 cause 】
2 、 Uterine factors- (primary) :
● Dysplasia, deformity, uterine fibroids
● Hyperdistension of the uterine wall and loss
of normal contractile capacity of the
myofibers (macrosomia,hyperamniotic
fluid)
● Senile age, parturient, intrauterine infection,
uterine fibrosis, connective tissue
hyperplasia and so on influence uterine
contraction
【 cause 】
3 、 Mental factors
Parturient's fear, mental overtension
make cerebral cortex function disorder,
waiting for labor long time, sleep less,
fatigue, bladder filling, eating
insufficiency, premature use of
abdominal muscle strength lead to
physical exertion, water and electrolyte
disturbance, etc.
【 cause 】

4 、 Endocrine factor

5 、 Effects of drugs
【 clinical manifestations 】
1. Coordinated uterine inertia/hypotonic uterine inertia:
It has the characteristics of uterine contraction
(rhythm, symmetry and polarity), but the
intensity of uterine contraction is weakened, the
duration of uterine contraction is short, the
intermittent time is long or irregular, the uterine
contraction is less than 2 times /10 minutes, the
uterine wall is not hard during uterine
contraction, and the uterine cavity pressure is
less than 15mmHg.
Most of the coordinated uterine inertia are
secondary uterine inertia,that is, the early stage
of labor is normal, the uterine contraction is
weakened at the end of the first stage of labor
or the second stage of labor, it is common in
contracted midpelvis and contracted pelvic
outlet; and the descend of fetal presentation is
blocked. It has little effect on the fetus.
【 clinical manifestations 】
2. Uncoordinated uterine inertia
/hypertonic uterine inertia.

Loss of rhythms and symmetry of normal uterine

contractions

Polar inversion of normal uterine contraction

● This kind of uterine inertia belongs to
-
primary uterine asthenia, that is to say,
there is uterine inertia at the beginning
of labor process, which needs to be
distinguished from false parturition.
• cephalopelvic disproportion and
abnormal fetal position.
● The parturient had conscious pain in the lower
abdomen, refusal to press,- restlessness, dehydration in
severe cases, electrolyte disturbance, flatulence,
retention of urine, fetal-placenta circulatory disorder,
fetal distress.

● Obstetric examination:
lower abdominal tenderness, fetal position not clear,
abnormal fetal heart, uterine dilation slow or stop,
prolonged latent phase,protacted descent\arrested
descent.
【 clinical manifestations 】
3. prolonged labor
●prlonged latent phase
●protracted active phase
arrested active phase
●protacted descent
arrested descent
protracted second stage
【 influence 】
1. Effects on puerpera:
● Prolonged labor leads to mental and physical
exhaustion, intestinal distension, difficulty in urination,
dehydration and electrolyte disorders.
● When the second stage of labor is prolonged,
vesicovaginal fistula or urethrovaginal fistula may
occur.
● Frequent vaginal examinations during labor increase the
chances of postpartum infection.
● postpartum uterine inertia is easy to cause postpartum
hemorrhage.
【 influence 】

2. Effects on the fetus:

● fetal distress in uterus:
Fetal and placental circulatory disorders
are prone to fetal distress in the
uncoordinated uterine inertia.
● Increase the rate of operation
● 【 prevention and treatment 】

● When the labor process is prolonged or

stagnated, there are often signs of uterine inertia.

● Priorto the adoption of measures to strengthen

contractions, it should be clear that there is no
obvious cephalic asymmetry and fetal
abnormalities.
 【 prevention and treatment 】
A. hypotonic uterine inertia
● first stage of labor
general treatment
● Psychological nursing: eliminate mental tension;
● Encourage take food or intravenous hydration of
water, electrolytes and energy;
● Rest and use sedatives as appropriate;
● Urination or catheterization;
【 prevention and treatment 】
2. Strengthen uterine contraction
1)artificial rupture of membranes
● indicatio ：
the dilatation of the uterine cervix is greater than
or equal to 3 cm, without cephalopelvic
disproportion, fetal head has been engaged and
labor process is delayed.
【 prevention and
treatment 】
2 ） intravenous infusion of oxytocin:
●indicatio
without cephalopelvic
disproportion, abnormal fetal
position and good fetal heart rate.
 【 prevention and
treatment 】
● the second stage of labor ：
delivery manners ：
vaginal delivery—Strengthen uterine contraction
cesarean section.
● the third stage of labor ：

Pay attention to prevent postpartum hemorrhage

and postpartum infection
 【 prevention and treatment 】

B. Incongruous uterine atony

Eliminate uncoordinated uterine
contractions:
● Intramuscular injection of pitidine
100mg or morphine 10mg;
● Diazepam 10mg intravenous injection
§ 2 metrypercinesia
1. The coordinated uterine contractions are too
strong

● The rhythm, symmetry and polarity of

contractions are normal
● the intensity and frequency of uterine
contractions were higher than normal.
● When there is no resistance in the birth
canal, the coordinated uterine contractions
are too strong can lead to the dilatation of
the uterine cervix quickly and the delivery
will end in a short time.
● precipitate delivery
● pathlogic retraction ring
【 influence 】
1 : Effects on puerpera:
● birth canal injury, amniotic fluid embolism,
● puerperal infection, placenta retention or
postpartum hemorrhage.
● 2: Effects on fetus
● Fetal distress, neonatal asphyxiation and even
death
● Neonatal intracranial bleeding or trauma
● Neonatal infection
【 prevention and treatment] 】

1. Those with a history of emergency birth will be

hospitalized in advance, and they will be ready to deliver
and rescue the newborn as soon as the signs of labor
appear

2. Oxygen is inhaled during labor, and the fetal heart rate

is noted

3. Carefully check the soft birth canal after delivery

【 prevention and
treatment] 】
4. Prevent postpartum hemorrhage and
postpartum infection
5. Neonates are injected with tetanus
antitoxin and vit K